Study On The Correlation Between Insulin-like Growth Factor 1 And Left Ventricular Mass Index In Obese Children

Research background and Purposes:Obesity(OB)is a chronic disease caused by multiple causes,which is closely related to metabolic syndrome and cardiovascular disease such as hypertension,diabetes,liver and kidney dysfunction,endocrine system metabolic disorder.Being overweight in childhood increases the risk of persistent obesity and related cardiovascular metabolic diseases in adulthood.Research has found that simple obese children have a significant decrease in cardiac diastolic function compared to normal weight children,indicating that obese children have experienced early cardiovascular system damage.Insulin like growth factor 1(IGF-1)is a key regulatory factor for postnatal growth and development,and its secretion is regulated by multiple participants in the growth hormone IGF-1 axis.Research has shown that the concentration of IGF-1 in the blood of obese children is relatively low,and relatively low IGF-1 levels are a risk factor for cardiovascular disease.Left ventricular mass(LVM)is a key determinant of left ventricular function.The left ventricular mass index(LVMI)is calculated from the left ventricular end diastolic volume,the thickness of the interventricular septum,and the thickness of the left ventricular posterior wall through relevant formulas,and is considered as an early predictor of adverse cardiovascular events.There is currently no relevant research on the correlation between IGF-1 levels and LVMI,an early predictor of cardiovascular events,in obese children.This study investigated the correlation between IGF-1 and LVMI in obese children aged 6-14 years old at a single center,further exploring the risk factors for obesity,drawing ROC curves,and evaluating their predictive efficacy.Provide direction for basic research on obesity related myocardial dysfunction in the future,and then provide relevant diagnosis and treatment ideas for obesity related cardiovascular disease intervention.Research objects and method:1.Research subjects:According to the guidelines of "Growth Curve of Body Mass Index in Chinese Children and Adolescents aged 0-18",inclusion and exclusion criteria were determined.104 obese children who visited the Children’s Health Clinic of Shandong University Second Hospital from July 2021 to November 2022 were selected as the case group,and 61 healthy children who underwent physical examination during the same period were selected as the normal control group.2.Research methods:2.1 Enrolled children shall undergo the following examinations:①Clinical examination:puberty development stage,weight,height(Ht);②Laboratory examination:measure IGF-1 level,fasting blood glucose(FBG),fasting insulin,triglycerides(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)Alanine transaminase(ALT)and uric acid(UA);③Perfect cardiac color Doppler ultrasound examination:continuously measure the left ventricular posterior wall thickness(LVPWT),left ventricular end diastolic dimension(LVEDD),and interventricular septum thickness(IVST)for three cardiac cycles,and obtain the average value.According to Deiereux’s LVM correction formula:LVM(g)=0.8×one point zero four×[(IVST+LVPWT+LVIDd)3-LVIDd3]+0.6,and then calculate LVMI by the ratio of left ventricular mass to body surface area(BSA);④Excluding confounding factors such as gender and age between the two groups,IGF-1 SDS was used to replace IGF-1,Body mass index(BMI)was converted toBody mass index standard deviation scores(BMI SDS),and Ht was converted to Height standard deviation scores(Ht SDS).2.2 Observe and compare the clinical and laboratory data characteristics measured between the obesity group and the healthy control group.Then observe and compare the differences of IGF-1 SDS,LVMI,lipid metabolism index,endocrine metabolism index and anthropometry data between obese children and healthy control children.Correlation analysis was used to evaluate the correlation between IGF-1 SDS,Homeostasis model assessment of insulin resistance(HOMA-IR),uric acid,glutamic transaminase,triglyceride,cholesterol,high-density lipoprotein,low-density lipoprotein and LVMI.After excluding confounding factors,multiple linear regression analysis was used to explore the linear correlation between IGF-1 SDS and LVMI.Using the method of single factor analysis,the general data of the obese group and the control group were compared,and the risk factors for childhood obesity were screened at the P<0.05 level.Incorporate the above related factors into binary logistic regression analysis to identify the risk factors for childhood obesity.Draw ROC curves based on obesity risk factors to evaluate the predictive value of obesity risk factors on childhood obesity.Research result:1.There was a statistical difference(P<0.05)in the relevant indicators measured between the two groups of study subjects(Ht SDS,BMI SDS,LVMI,IGF-1 SDS,HDL-C,LDL-C,HOMA-IR,UA,TC,TG,ALT).The insulin like growth factor 1 standard deviation scores(IGF-1 SDS)and HDL-C of obese children were significantly lower than those of the normal control group(P<0.001),but the height standard deviation scores(Ht SDS),BMI SDS,HOMA-IR,LVMI,UA,TC,TG,ALT were significantly higher than those of the normal control group(P<0.001).2.In 165 study subjects,multiple variables were analyzed for Person correlation with LVMI.The results showed that IGF-1 SDS(r=-0.211,P<0.05),HDL-C(r=-0.168,P<0.05)were significantly negatively correlated with LVMI levels.BMI SDS(r=0.25,P<0.001),HOMA-IR(r=0.27,P<0.001),LDL-C(r=0.172,P<0.05),ALT(r=0.155,P<0.05)showed a significant positive correlation with LVMI levels.TC,TG,UA have no significant correlation with LVMI.3.In multiple linear regression analysis,after controlling for confounding factors such as sexual development stage,gender,age,TC,TG,and UA,IGF-1 SDS showed a dominant linear negative correlation with LVMI,while HOMA-IR showed a dominant linear positive correlation with LVMI.For every 1 unit increase in IGF-1 SDS,LVMI decreases by 16.1%(β-0.161;P<0.05);For every 1 unit increase in HOMA-IR,LVMI increases by 24.1%(β 0.241;P<0.05).4.In binary logistic regression analysis,after controlling for sexual development stage,gender,and age,childhood obesity was influenced by multiple factors,mainly including IGF-1 SDS,HOMA-IR,HDL-C,UA,and TC.Among them,a decrease in IGF-1 SDS(OR=3.678,95%CI:1.445-9.36,P<0.05),a decrease in HDL-C(OR=0.008,95%CI:0.001-0.039,P<0.05),an increase in HOMA-IR(OR=0.141,95%CI:0.032-0.611,P<0.05),an increase in TC(OR=0.003,95%CI:0-0.303,P<0.001),and an increase in UA(OR=0.982,95%CI:0.966-0.998,P<0.05)are risk factors for childhood obesity.5.Draw ROC curves based on each risk factor,calculate the Jordan index,significance(P-value),specificity,and sensitivity,and determine the optimal cutoff point based on the Jordan index.The predictive performance evaluation of individual risk factors shows that HOMA-IR(AUC=0.929,Jordan index 0.819)has the best predictive performance,followed by LDL-C(AUC=0.86,Jordan index 0.648),ALT(AUC=0.83,Jordan index 0.556),TG(AUC=0.821,Jordan index 0.487)UA(AUC=0.793,Jordan index 0.469),TC(AUC=0.766,Jordan index 0.49),LVMI(AUC=0.739,Jordan index 0.493),IGF SDS(AUC=0.245,Jordan index 0).Analysis conclusion:1.There is a linear negative correlation between IGF-1 SDS and LVMI in obese children.2.Childhood obesity is influenced by multiple factors,mainly including IGF-1 SDS,HOMA-IR,HDL-C,UA,and TC.Among them,a decrease in IGF-1SDS,a decrease in HDL-C,an increase in HOMA-IR,an increase in TC,and an increase in UA are risk factors for childhood obesity.